A Matter of Principle - CASE STUDY

In early 1982 Ms. Corrine Worthen, a registered nurse, protested against assignment to perform kidney dialysis upon a terminally ill patient who was a double amputee. She notified her head nurse that she "had moral, medical, and philosophical objections" against doing so. Prior to her protest Ms. Worthen had performed the procedure on the patient and twice had to interrupt it because the patient suffered cardiac arrest and severe hemorrhaging. Convinced that the procedure was more harmful than beneficial to the patient, Ms. Worthen asked to be reassigned. The head nurse granted her request.

Several months later, however, Ms. Worthen again was called upon to dialyze the patient. She objected, stating that she thought she had worked out an agreement not to be given this assignment. The head nurse referred Ms. Worthen to the treating physician who informed her that the patient's family wanted the patient kept alive, and that the patient would soon cease to live without dialysis. Nonetheless, Ms. Worthen said she refused to dialyze the patient anymore. The head nurse then warned her that she would be fired if she continued in her refusal. Ms. Worthen continued to refuse to dialyze the patient, and she was terminated.

The Code of Professional Ethics for Nurses, that applied to Ms. Worthen at the time she was fired, contained a provision with the following words:

1.4 THE NATURE OF HEALTH PROBLEMS

The nurse's respect for the worth and dignity of the individual human being applies irrespective of the nature of the health problem. It is reflected in the care given the person who is disabled as well as the normal, the patient with the long-term illness as well as the one with acute illness, or the recovering patient as well as the one who who is terminally ill or dying. ….

If personally opposed to the delivery of care in a particular case because of the nature of the health problem or the procedures to be used, the nurse is justified in refusing to participate. Such refusal should be made known in advance and in time for other appropriate arrangements to be made for the client's nursing care. If the nurse must knowingly enter such a case under emergency circumstances or enters unknowingly, the obligation to provide the best possible care is observed. The nurse withdraws from this kind of situation only when assured that alternative sources of nursing care are available to the client.

Ms Worthen sued the hospital for terminating her and lost.

Notes:

Fifth Intercollegiate Ethics Bowl, APPE, 2000

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